Annals of Surgical Oncology ( IF 3.4 ) Pub Date : 2023-12-06 , DOI: 10.1245/s10434-023-14685-9 Kosei Takagi 1 , Tomokazu Fuji 1 , Motohiko Yamada 1 , Jiro Kimura 1 , Kazuya Yasui 1 , Yuzo Umeda 1 , Toshiyoshi Fujiwara 1
Background
Sufficient knowledge and surgical management of portal annular pancreas (PAP) are essential for pancreatic surgery. As PAP is a relatively rare pancreatic anomaly, few studies have described surgical techniques for patients with PAP undergoing robotic pancreatoduodenectomy (RPD).
Patients and Methods
An 82-year-old female patient who underwent RPD presented with distal cholangiocarcinoma and type III PAP (the fusion of the uncinate process with the anteportal main pancreatic duct). After the Kocher maneuver and stomach transection, the pancreas was transected into the neck of the anteportal portion. The retroportal portion was dissected, encircled with hanging tape, and compressed. Blood supply from the mesenteric vessels was confirmed using indocyanine green (ICG) fluorescence imaging. Subsequently, the retroportal portion was stapled.
Conclusions
This study demonstrates a unique surgical technique for type III PAP using the hanging maneuver with ICG fluorescence imaging. Surgeons should decide on the surgical strategy on the basis of the fusion and ductal anatomy of the pancreas.
中文翻译:
使用吲哚菁绿荧光成像悬挂操作进行门环胰腺机器人胰十二指肠切除术
背景
门环胰腺(PAP)的足够知识和手术管理对于胰腺手术至关重要。由于 PAP 是一种相对罕见的胰腺异常,因此很少有研究描述接受机器人胰十二指肠切除术 (RPD) 的 PAP 患者的手术技术。
患者和方法
一名接受 RPD 的 82 岁女性患者出现远端胆管癌和 III 型 PAP(钩突与前门脉主胰管融合)。在 Kocher 操作和胃横断后,将胰腺横断到前门部分的颈部。解剖门静脉后部分,用悬挂胶带环绕并压缩。使用吲哚菁绿(ICG)荧光成像证实肠系膜血管的血液供应。随后,缝合门静脉后部分。
结论
本研究展示了一种独特的 III 型 PAP 手术技术,采用悬挂操作和 ICG 荧光成像。外科医生应根据胰腺的融合和导管解剖来决定手术策略。